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estabilized at VL 190000?!
Oct 7, 2003

Dear Dr. Young,

Thank you very much for your invaluable help. I need a second opinion. I went through ARS in may (tested neg back then). By the end of july my VL was 190000 and CD4 342/CD8 666. My doctor said that it was normal because it was so early on in the infection and that we should wait. On september 16th my VL was 185000 and CD4 342 (exactly the same as before)/CD8 750. My Doctor says that I still have not estabilized and has told me to get tested again the 1st of december!! 1) Should I wait that long? Is it safe? 2) Why are my figures so alarming so early on and why do you think they have not recuperated? Could I be a rapid progressor? 3) Should I start on meds straight away with such a high viral load despite the fact that I have only been infected for a few months? 4) Does the increase in CD8 cells have any significance?

I am extremely grateful for any help you can offer.

Response from Dr. Young

Thanks for your question.

I'm less certain that you're still in the "acute" phase of infection-- this usually lasts only about 8-12 weeks, and as such you should be at your viral "setpoint" by now.

If your interested and willing to start therapy for acute infection, then waiting until December is not in your best interest, since early therapy is probably more effective. If, on the other hand, you're not interested in starting therapy, then waiting until December won't have any significant impact.

Having a high initial, baseline viral load is of some concern, but I don't think that I would be overwhelmed-- yes, higher viral loads typically correlate with more rapid progression, but with contemporary therapies, persons with high viral loads respond very well to treatment. We really don't understand why some persons have high initial viral loads and others lower, though it probably has something to do with your body's immune response to HIV. The major issue is that it is more likely that you'll start therapy sooner than later (exactly when would be based on how your CD4 cells decline), and the key thing is to not let too much time pass between lab tests (I recommend every three- to four months.) Good luck. BY


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